The Effect of Temporal Right Atrial Appendage Pacing against Cardioversion-Refractory Ventricular Tachycardia in Acute Worsening of Dilated Cardiomyopathy

概要

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Thirty-nine year old man admitted to our institute because of acute worsening of congestive heart failure (CHF) due to dilated cardiomyopathy. He was in severe low output syndrome (LVEF<10%) and treated with intensive care under Swan-Ganz monitoring. However, condition was refractory against intensive therapy and hemodynamic state became unstable. According to the worsening of CHF ventricular tachycardia (VT) with 126 bpm was appeared, and neither the intravenous administration of amiodarone nor cardioversion could terminate VT. Hemodynamic state got worsened with sustained VT, Which needed to intra-aortic balloon pump back up. Subsequently, electrophysiological study was performed, and intracardiac electrogram showed dissociation between atrium and ventricle that proved VT. We performed over drive pacing from right atrial appendage (130 bpm); both the narrowing of QRS morphology due to re-synchronization of intraventricular conduction and atrioventricular synchrony were gained resulting in rise of systemic blood pressure and cardiac output. He transferred to another institute to have left ventricular assist device (LVAD), and now he was can walk with LVAD and is waiting for a chance to receive heart transplantation. We experienced a case that overdrive atrial pacing have improved cardiac function during VT.